- CenterLight Health System (NY)
- …appropriate. + Review and analyze monthly financial reports submitted by Medicare related to diagnostic data. + Present HCC/RAF performance results and findings ... sites around NYC) as well as other entities within the organization. + Review coding and billing process for operational enhancements. Responsible for reviewing and… more
- Amgen (New York, NY)
- …through payer prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has specifically requested ... to HCPs on how the products are covered under the benefit design (Commercial, Medicare , Medicaid) + Serve as a payer expert for defined geography and promptly… more
- Molina Healthcare (New York, NY)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services… more
- Stony Brook University (Stony Brook, NY)
- …may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR from the ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...Documents over utilization of resources and services. + All Medicare cases are reviewed for level of care on… more
- Stony Brook University (East Setauket, NY)
- …following, but are not limited to:** + Prepare and submit hospital claims. Review denials. Investigate coding issue. Audits. + Follow-up on rejected or denied ... agencies. + Identify issues and patterns with claims and insurance companies and review to increase revenue and prevent unnecessary denials. + Assist the supervisor… more
- Stony Brook University (East Setauket, NY)
- …following, but are not limited to:** + Prepare and submit hospital claims. Review denials. Investigate coding issue. Audits. + Follow-up on rejected or denied ... collection agencies. + Identify issues and patterns with claims/insurance companies and review to increase revenue and prevent unnecessary denials. + Assist the… more
- Ellis Medicine (Schenectady, NY)
- …by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and social workers for ... in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly preferred. Home care, payer, or… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for ... for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for ... for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources.… more
- Elevance Health (East Syracuse, NY)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... issues as assigned. + Participates in special projects and review of work done by lower level auditors as...a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience,… more